Provider Demographics
NPI:1063594554
Name:RUMILLA, ALFREDO ESTEVAN II (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:ESTEVAN
Last Name:RUMILLA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2554 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3148
Mailing Address - Country:US
Mailing Address - Phone:773-687-9490
Mailing Address - Fax:773-687-9637
Practice Address - Street 1:2554 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3148
Practice Address - Country:US
Practice Address - Phone:773-342-8888
Practice Address - Fax:773-342-6257
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021623247OtherILLINOIS BLUE CROSS/BLUE
G57308Medicare UPIN
IL0021623247OtherILLINOIS BLUE CROSS/BLUE